Organization
RESTORE HEALTH CORP
Active
Other names
MTM Pharmacy I
Organization subpart
No
Provider details
NPI number
Authorized official
TINA TUYET QUACH-TRAN (OWNER/PRESIDENT/CEO)
(714) 705-6992
Entity
Organization
Contact information
Practice address
12666 BROOKHURST ST STE 110, GARDEN GROVE, CA 92840-4866
(714) 705-6992
Mailing address
12666 BROOKHURST ST STE 110, GARDEN GROVE, CA 92840-4866
(714) 705-6992
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7217942
—
CA
01
—
PHY57946
PHARMACY LICENSE
CA
Enumeration date
04/29/2022
Last updated
05/02/2022
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